HealthApril 03, 2024

Three key considerations in fortifying drug diversion prevention programs

In the ever-evolving landscape of healthcare, the challenge of drug diversion has become increasingly complex. 

Drug diversion, or when healthcare workers illegally obtain or use prescription drugs intended for a patient, jeopardizes patient safety and workforce well-being – while nearly all leaders agree that drug diversion occurs, 79% of healthcare executives believe that most drug diversion goes undetected, according to findings from the 2023 State of Drug Diversion Survey. Increasing staff turnover in the wake of the COVID-19 pandemic has complicated prevention efforts further— in 2020, less than half (47%) of healthcare executives expressed high confidence that their facility’s drug diversion program met audit requirements for the DEA, Board of Pharmacy and Joint Commission (The State of Drug Diversion 2020 Report). 

Throughout the entire medication supply chain, diversion is a real, ever-present risk that can occur anywhere from the initial purchase to the patient, including the disposal of expired or wasted products. Diversion also does not discriminate between controlled and non-controlled substances—with high street value medications like antivirals (e.g., HIV medications) and Ozempic, and frequently diverted medications like propofol and Benadryl remaining targets of diversion alongside controlled substances such as opioids and prescription pain medications.

To combat this threat to patient and staff safety, health system staff must rigorously track medications within the hospital, effectively leverage tools and technology, and collaborate continuously to protect the community in and outside of the hospital against the risks of drug diversion. With that in mind, a recent panel of pharmacy leaders, including Alison Apple, RPh, MS, Chief Pharmacy Officer at the Hospital of the University of Pennsylvania, Loretta Lemoine, PharmD, BCPS, Inpatient Pharmacy Director at JPS Hospital, Marilen Martinez, Pharm.D., BCPS, Information Technology Pharmacy Specialist at Henry Ford Health System and Tom Knight from Wolters Kluwer Health, revealed three key components to a successful drug diversion program: 

Take a multidisciplinary approach

Implementing a robust drug diversion prevention program requires a collaborative effort across various departments and individuals within the health system. While pharmacy leaders may be driving diversion prevention efforts in some hospitals, nursing, anesthesia providers, HR and other departments should all take an active role in creating and executing a comprehensive prevention strategy.  A program that involves stakeholders from many departments and individuals throughout the health system is much more likely to be successful than a program operating in a silo. 

“For our program, what we did was bring together a drug diversion governance committee—an overall group that encompasses all of our different points of care –  ambulatory sites, retail sites, campuses –  involving pharmacy, nursing, security, legal and senior leadership,” said Alison Apple, RPh, MS, Chief Pharmacy Officer at Hospital of the University of Pennsylvania. “We tried to bring everybody together to work on drug diversion—not just pharmacy.”

Loretta Lemoine, PharmD, BCPS, Inpatient Pharmacy Director at JPS Hospital, noted a similar approach, with monthly committee meetings involving personnel from nursing, HR and security in addition to pharmacy to ensure a comprehensive approach.

Building trust between departments and fostering a team mentality are key components of this collaborative approach. Organizing regular interdepartmental meetings to discuss potential challenges and share best practices and establishing open lines of communication between departments to flag concerns is critical to successfully preventing harm to patients and staff alike.

Leverage technology

Embracing technology is another fundamental aspect of modern drug diversion prevention. In today's dynamic healthcare environment, manual tracking alone is often insufficient and ineffective, forcing health systems to be more reactive instead of proactive. In fact, Marilen Martinez, PharmD, BCPS, Information Technology Pharmacy Specialist at Henry Ford Health System compared using older technology like monthly reports and random audits alone to searching for a needle in a haystack. Artificial intelligence (AI)-enabled technology can integrate data from automated dispensing cabinets (ADCs), Electronic Health Records (EHRs), time clocks, and purchasing systems to create a comprehensive system that facilitates proactive diversion prevention and can detect diversion months sooner than manual efforts alone. 

Investing in advanced data analytics tools that process information from multiple IT sources simultaneously—as well as regularly updating technology— is vital to stay ahead of ever-evolving diversion methods and can help alleviate the reporting burden on hospital staff. AI-powered tools like Sentri7 Drug Diversion are uniquely positioned to help teams stay one step ahead of what can feel like an overwhelming problem. Continuous improvement in technological infrastructure ensures that health systems can remain agile and effective in preventing drug diversion.

Continuously improve the program

Once systems are in place, healthcare system and program leaders need a proactive approach to continually seek ways to enhance the program. Conducting ongoing training sessions that actively involve staff ensures that the workforce is well-equipped to identify and appropriately respond to potential diversion incidents. Additionally, departments across the health system should regularly review and update access permissions to where drugs are stored, based on job roles and responsibilities to maintain the integrity of the program. 

Avoiding complacency is paramount to the success of any drug diversion prevention program. Actively soliciting feedback from frontline staff is a valuable method to gain insights into potential areas for improvement. By establishing a culture of continuous learning, staff are more empowered to stay ahead of the latest trends and methods in drug diversion prevention. As the healthcare landscape evolves, leaders should remain adaptable, adjusting the use of teams, tools, and technology to address new challenges effectively.

“As a pharmacy director, having a software program is one thing that helps me sleep at night, because we have a better sense of what’s going on, and where our opportunities are. It’s all about performance improvement,” Apple explained during the panel.

Effective drug diversion prevention programs require a multifaceted approach that encompasses interdepartmental collaboration, technological innovation, and a commitment to ongoing improvement. While there’s no one-size-fits-all approach, by adopting these best practices, health systems can reduce oversight, alleviate the burden on staff, and most importantly, enhance patient and community safety. As the landscape evolves, so too must strategies and tools for combating drug diversion. Learn about Sentri7 Drug Diversion (formerly Invistics’ Flowlytics solution) and Drug Diversion prevention resources.

This article is adapted from an ASHP 2023 Continued Education panel session which took place on December 5, 2023; featuring Loretta Lemoine, Inpatient Pharmacy Director at JPS Hospital Fort Worth; Marilen Martinez, Pharm.D., BCPS, Information Technology Pharmacy Specialist at Henry Ford Health System; Alison Apple, Chief Pharmacy Officer at the Hospital of the University of Pennsylvania; Tom Knight, Wolters Kluwer Health.

Learn About Sentri7 Drug Diversion
Manager of Pharmacy Services and Fellowship Director
Dr. Steve Mok has over a decade of experience in the areas of antimicrobial stewardship, infectious diseases and clinical pharmacy management. He has practiced in a variety of settings.
Sentri7 Drug Diversion
Quickly uncover potential diversion from purchase to patient with predictive analytics and actionable dashboards.
Reconciles drug transactions using AI to rapidly and accurately identify patterns of behavior consistent with drug diversion.
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